MARCH 19TH

Serving God is Doing Good to Man, but Praying is thought an easier Service, and therefore more generally chosen.

— Benjamin Franklin,1753

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CHAP. XXVI.Of the Amputation of the Cancer'd and Scirrhous BREAST.

THE Success of this Operation is exceedingly
precarious, from the great Disposition there is in the Constitution
after an Amputation, to form a new Cancer in the Wound, or some
other Part of the Body. When a Scirrhus has admitted of a long
Delay before the Operation, the Patient seems to have a better
Prospect of Cure without danger of a Relapse, than when it has
increased very fast, and with acute Pain. I cannot however be
quite positive in this judgment, but upon looking round amongst
those I know who have recovered, find the Observation so far
well-grounded. There are some Surgeons, so disheartened by the
Ill-success of this Operation, that they decry it in every Case,
and even recommend certain Death to their Patients, rather than
a Trial, upon the Supposition it never relieves; but the Instances,
where Life and Health have been preserved by it, are sufficiently
numerous, to warrant the Recommendation of it.

The Scirrhus may be distinguished, by its
want of Inflammation in the Skin, its Smoothness and Slipperiness
deep in the Breast, and generally, by its pricking Pain, which
as it is more or less, increases the Danger accordingly; tho'
there are some few with little or none in the Beginning. As the
Tumour degenerates into a Cancer, which is the worst Degree of
Scirrhus, it becomes unequal and livid, and the Vessels growing
varicous, at last ulcerates.

In extirpating the Scirrhus, if it be small,
a longitudinal Incision will dilate sufficiently for the Operation,
but if too large to be dissected out in that manner, an oval
Piece of Skin must be cut thro' first, the Size of which is to
be proportioned to that of the Tumour; for example, if the Swelling
is five Inches long, and three broad, the oval Piece of Skin
cut away must be nearly of the same Length, and about an Inch
and a half in Breadth. In taking off the whole Breast, the Skin
may be very much preserved, by making the Wound of it a great
deal less than the Basis of the Breast, which must be carefully
cleared away from the Pectoral Muscle: This is not difficult
to do, because all these Scirrhuses being enlarged Glands, are
encompassed with their proper Membranes, which make them quite
distinct from the neighbouring Parts, and easily separable; at
least this is the Case, when the Tumour is moveable; for sometimes
it adheres to the subjacent Muscle, and that Muscle to the Ribs;
in which Circumstance, the Operation is impracticable. When it
is attended with Knots in the Armpit, no Service can be done
by Amputation, unless the Knots be taken away; for there is no
sort of Dependance to be laid on their subsiding, by the Discharge
of the Wound of the Breast: The Possibility of extirpating these
Knots, without wounding the great Vessels, is very much questioned
by Surgeons; but I have often done it, when they have been loose,
and distinct.

The Bleeding of the large Arteries is to be
stopped by passing the Needle twice through the Flesh, almost
round every Vessel, and tying upon it, which will necessarily
include it in the Ligature. In order to discover the Orifices
of the Vessels, the Wound must be cleaned with a Spunge wrung
out of warm Water.

The scirrhous Tumours which appear about the
lower Jaw, are generally speaking scrophulous Disorders, that
distinguish themselves almost by the Circumstance of fixing on
the Salivary Glands. These are very stubborn of cure, but not
so bad as the Scirrhus, since they frequently suppurate, and
heal afterwards: If they impostumate again after healing, 'tis
for want of a good Bottom, which may sometimes be procured by
destroying their bad Surface with a Caustick. Besides these,
there is another Species of Scirrhus in the Neck, that succeeds
better after Extirpation than either of the former kinds; this
is an Enlargement of the Lymphatick Glands, which run close up
by the Jugular Vein, and is distinguishable from Cancers of this
Part, by its Moveableness, want of Pain, the Laxness of the Skin
covering it, the small Degree of Pressure it makes on the OEsophagus
and Trachea; and lastly the good Habit of Body, as it
seldom affects the Constitution, which Cancers here do very early,
after their first Appearance. This Tumour, from its Situation,
requires great Exactness in the cutting off: the last I took
away of this kind, I separated from the jugular Vein near the
length of an Inch and a half: they sometimes extend up to the
Chin towards the Mouth, and occasion a Division of the Salivary
Duct in operating, which proves very troublesome to heal, but
when all other Methods have failed, may be cured by a Perforation
into the Mouth, through that Part of the Check where it is wounded,
which by a Tent or small Seton may be made fistulous; then by
properly dressing upon the Outside, the Oozing of the Saliva
that Way will be prevented, and the external Orifice healed without
Difficulty.

The Treatment of all these Wounds may be with
dry Lint first, and afterwards as in the common incised Wounds.